The present invention relates to devices for use in surgical procedures which are performed in proximity to one or both ureters of a patient, and in which it is necessary for the operating physician to be aware of the location of the ureter or ureters in order to assure that they will not be injured by the surgical procedure.
In various operations involving inflammatory or malignant tumors in the pelvis or abdomen, as well as other explorations and procedures, it may be difficult for the operating physician to be aware of the location of the ureters. By way of example, in laparoscopic abdominal and pelvic surgery, the operating physician may have limited vision of the surgical site and also does not have benefit of tactile input which is available during conventional open surgery. Therefore, there is an increased risk of injury to the ureter during such surgery.
It has already been proposed in the art to reduce the risk of ureteral injury by introducing a light source into one or each ureter. Light from the source will diffuse through the ureter wall, thus making the ureter visible to the operating surgeon.
Two devices of this type have been proposed. One of these, marketed by Pilling Rusch (a International Company), utilizes a Bush Ureteral Illuminator in association with a transparent ureteral catheter. The Illuminator includes two fiber-optic bundles with light-emitting segments along its ureteral length. Each of these bundles can be introduced into a transparent ureteral catheter after each catheter has been inserted into a respective ureter. When the Illuminator is connected to a light source, the ureters may be illuminated for visualization.
Another illuminator, a fiber optic ureteral probe, is marketed by Karl Storz. This device is an illuminating ureteral probe designed for illuminating the ureter during operative procedures. The device consists of cold light fibers constructed to create a band of light every centimeter along its length, to aid in measurement. The probe is connected to a cold light fountain and is placed in the ureter by a cystoscope before or in the course of a surgical procedure. The probe can be both palpated and, as a result of the light emission, visualized during a surgical procedure.
Both of the above-described devices have several drawbacks, including the fact that they are difficult to insert in a ureter, particularly when there is secondary pathology in the pelvis or a stenosis in the ureter. As a result, on many occasions, the illuminating device would not be properly placed. In addition, assembly of the known Bush device requires insertion of the optical fiber bundles into the catheters in the operating theater after cystoscopic placement of the catheters, which is a difficult exercise. The device does not have an effective system for securing the fiber bundles in the catheters, and many times they will migrate out of the catheters.
Furthermore, the known devices essentially completely fill the ureteral channel, preventing proper drainage of urine during the time the devices are in place.